Mid-Range Nursing Theory

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on individuals who frequently utilize the emergency department (super-utilizers); and targeting the needs of individuals with behavioral health problems. (Mann, 2014, pp 2-4) Many resources and processes have been implemented in order to help decrease inappropriate emergency department visits. This paper is going to demonstrate some resources and processes that are in place to help individuals obtain health care at the appropriate health care setting.

The patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People

As health care continues to evolve, these changes may facilitate or hinder the availability of health care resources for lower income populations. According to the American Association of Nurse Practitioners (2017), “By providing high-quality care and counseling, NPs can lower the cost of health care for patients” .Moreover, practicing at the primary care level, and focusing on prevention, counseling, and screening will help decrease the prevalence of inpatient hospitalizations due to people not understanding their health. As an FNP in primary health care setting, I will have the ability to see my patients for wellness visits, and reinforce the routine knowledge needed for them to make ideal life style choices, that will maintain their good health. The overall goal, which I want to obtain in this vital role is to change the mind set of individuals to disease

In some areas of population health, technology in enhanced patient information is utilized to perform risk stratification to identify the high risk patients. These patient’s often have uncontrolled BP, diabetes with an HgbA1c over 9, COPD, etc. Once identified as high risk or potential high risk, these patients receive additional care or patient outreach to help manage their condition. Some organizations employee RN Health Coaches and Care Coordination teams to help these patients and identify gaps in care. The primary care physician assumes care of the patient along with striving for the patient to become active in their overall health thereby keeping them out of the hospital (Sanford, 2013). One enhanced area of population management is the PCMH model. PCMH practices increase patient’s engagement in shared decision making while providing compensation for care coordination, care management and medical consultation outside of traditional face-to-face visits (Berryman, Palmer, Kohl &Parham, 2013). A patient centered approach pushes for changes not only in the delivery of medicine but in traditional encounters. In addition, PCMH encourages increased access to the patient’s primary care physicians and improved patient satisfaction scores. PCMH and population health encourages providers to increase after hours care to decrease emergency department visits and/or hospitalizations. Thereby reducing cost and improving the patient’s

The education that I have participated in within the vulnerable population includes when to call your physician and when it is appropriate to go to the emergency room. In the Super Utilizer program one client had been visiting the emergency room frequently, sometimes as much as three times a week. With this occurring it was important to provide education on when to call the physician and the appropriate times to go to the emergency room. In the first three or four weeks in the program the client had cut down to two visits to the emergency

I am a Nurse Manager in the hemodialysis unit. The unit has eleven stations with a patient population of 40. The age range of veterans that receive care in this unit is 40 – 92. Most of the hemodialysis patients have difficulty managing their chronic illness and usually receive treatment three times a week for five hours of each visit. Most of them have

The health care policy for many years has posed significant challenges for administrators within the federal system, which also span in the public, nonprofit and business arena. One of the administrative agency’s primary area of focus is to educate individual through preventive

There are many issues in nursing that we, as nurses, can have a profound impact on changing. Using nursing theory, we can improve clinical practice and thereby positively influence the health and quality of individuals (McEwen & Wills, 2014). Benner’s theory of Novice to Expert illustrates how nurses evolve through clinical experience and education to become expert clinicians. Theory can be used to guide nursing practice when combined with clinical knowledge and critical thinking; such is the case in the ambulatory (outpatient) care setting. Ambulatory care nursing is complex and encompasses autonomous, as well as collaborative practice using evidence based information across a variety of outpatient health care settings (AAACN, 2017). This paper will look at the lack of specialized nursing education in the ambulatory setting, as well as, Patricia Benner’s Novice to Expert middle-range nursing theory. It will also look at how Benner developed her theory and how her Novice to Expert Theory has been used previously in the ambulatory setting. Lastly, I will address how Benner’s theory could be used to address the lack of specialized nursing education in the ambulatory setting.

The presence of nurse practitioners (NP) in health care has been necessary for more than five decades. The American Association of Nurse Practitioners (AANP) indicates that there are over 205,000 NPs in the United States being utilized by Americans for their health care needs (AANP, 2015). NPs are a vital part of the modern health care system and are accepted by both health care consumers and other health care providers (Fairman, 2015). A study performed by Hart and Mirabella (2015), of emergency department patients determined that patients were satisfied with treatment by a NP in the past and were willing to receive treatment from the NP during their current visit. A study conducted in emergency departments in Canada indicated that NPs demonstrate attentiveness, comprehensive care, and role clarity (Thrasher 2008). These positive characteristics are critical components of patient satisfaction. Additionally, NPs have been utilized more especially with more American developing insurance coverage through health care reform. According to the Department of Health and Human Services (2013), those seeking services in primary care is expected to continually rise through 2020. This increased demand is largely due to the growth of an aging population and from the Affordable Care Act increase in insurance benefits. The Affordable Care Act, along with the shortage of primary care physicians, has expanded the role of the nurse

Nursing is a profession in which theories have been developed to help implement knowledge development into the practice since Florence Nightingale. Theories help to utilize research and what helps to guide our practice. According to Meleis (2018), theories can be examined through their levels of abstraction which include: grand theories, middle-range theories, and situation-specific theories. The purpose of this paper is to detail how middle-range theories are most applicable to clinical nursing practice in the 21st century.

Avoidable emergency department (ED) encounters places a significant burden on the health care system. Seniors 65 years or older have the highest rate of hospital encounters of any other age group (Bulut, Yazici, Demircan, Keles & Demir, 2015). The Center for Medicare and Medicaid (CMS) have placed stiff penalties on hospitals that are not able to reduce repeat encounters (“Coordinating better care & lowering costs”, 2017). These penalties result in the loss of guaranteed funding if the hospitals are not able to reduce readmission rates. Therefore, hospitals are seeking solutions to solving this challenge (“Coordinating better care & lowering costs”, 2017). Care transition teams are in place to help mitigate repeat encounters,

I have encountered patients with a wide range of accessibility to health care while working as an Emergency Department volunteer in Los Angeles. I began to recognize that improving delivery of health care services to underserved populations would eliminate the use of ER for primary care and the subsequent financial burden on our health care system. In addition, physicians can put the power in patients’ hands by educating them and providing preventative care. GW’s ISCOPES program provides the ideal opportunity to fight for these issues

Problem-Avoidable ED encounter places a burden on the healthcare system in the US. Seniors 65 years or older are identified as having the highest rate of avoidable encounters

With a goal to obtain a 33% reduction in ED utilization by recently discharged patients, the MTF devised the following strategies to facilitate care transitions and improve communication from inpatient units to clinics and between clinics and patients. Collectively the interventions were recognized as Project Red Light and consisted of developing a Health Insurance Portability and Accountability Act (HIPAA) compliant process for sharing acute care admission/discharge information with appropriate clinics and outpatient providers as well as scheduling follow-up appointments prior to discharge or by the next business day following discharge. Other program interventions involved utilizing a multi-disciplinary approach to discharge planning consisting of input from Care Coordinators, Primary Care Managers, Social Workers, and Discharge Planners.